• File for Life
  This form contains all the information needed by first responders to make sure they have vital information about you and your healthcare needs during that critical first hour after an accident or emergency. You may enter as much or as little information as you want. It's your form - your decision.
      WORD DOC >>
      PDF FILE >>
      (Use this PDF file if you cannot open
      the Word file.)

• Physicians Orders for Life Sustaining Treatment Form (POLST)
  This form complements an Advance Directive and provides details regarding your wishes regarding CPR, medical interventions and other possible treatments. Complete instructions and important information is on the form. You may also visit the POLST California website (hwww.capolst.org) for additional information about advanced care planning.
      PDF FILE >>

• Save My Pets!
  This form provides important information about your pets and their particular needs, including medications, allergies, their veterinarian, and tips for you to be sure they are cared for by making emergency contact information available to first responders.
      WORD FILE >>

• Doctor Authorization Form
  This document authorizes you doctor to complete the File for Life and Physicians Orders for Life Sustaining Treatment (POLST) forms for your review and subsequent approval and/or signature.
      PDF FILE >>

• Yellow Dot Brochure
  This document contains information about the Yellow Dot Program, including where to sign up, partners, where to get files and additional information.
      PDF FILE >>

• Advanced Care Directive - HELP!
  In order to ensure that our wishes are carried out when we cannot speak for ourselves, everyone needs to have an Advance Care Directive. The Advance Directive form available below may be used to spell out in detail all your instructions. If you're not comfortable doing that yet, you might consider something a little less comprehensive. You can do this by preparing a statement of your wishes, sign and date it. Dr. John R. Dykers, Jr., M.D. has shared his own end-of-life plan as follows: "if you can fix me, please do. If you can't fix me, please help me avoid pain, fear, lack of air, hunger, nausea, thirst, loss of dignity and prolonging the dying process. I understand that it might take a few days to figure out whether you can fix me or not." You can add your own words. This is a good way to start and to facilitate the conversation.

• Advanced Care Directive - FORM
  You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. The Advanced Care Directive form lets you do one or both of these things. It also lets you write down your wishes about donation of organs and the selection of your primary physician. You may complete or change any part of the form to meet your needs.
     PDF FILE >>

• Calaveras Community Foundation

• Mark Twain Hospital/Dignity Health

• Robert and Barbara Jones

• Calaveras Works & Human Services

• K.W. Emerson

• Calaveras Deputy Sheriff’s Association

• Calaveras County Fire Chief’s Association

• Calaveras Senior Centers

• The Volunteer Center

• Calaveras Behavioral Health

• Commission on Aging

• Citizen Corps Council

• American Legion Ambulance

• Steve Wilensky

• Calaveras County Public Health

. . . and Private Donations
  

If you would like to volunteer or make a financial contribution to ensure that this resource is available to all our citizens, please understand that no donation of time or money is too small. . . it all adds up!

You can make a difference!
Calaveras Yellow Dot Program Committee
(209) 754-1699 EIN #45-4345879
PO Box 196, San Andreas, CA 95249

If you need additional information, please call (209) 754-1699
or email calaverasvolunteer@caltel.com.

If you leave a message, include your name and phone number and
please speak slowly.
You will be contacted within a couple of days.

Remember, sign up today and
take advantage of this FREE program!